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Aim. The aim of the study was to determine causes of proton pump inhibitors (PPIs) inefficacy in some patients suffering from gastroesophageal reflux disease (GERD). Material and methods. In our study of 154 GERD patients, 50 received omeprazole, 51 - lansoprazole and 53 - pantoprazole in a standard daily dose. GERD symptoms (heartburn and regurgitation) were scored by Likert scale; the patients' quality of life (SF-36) and their mental status (SMALL) were examined. Upper gastrointestinal endoscopy, 24-h intraesophageal pH monitoring, esophageal manometry and pharmacokinetic study were performed. Results. The treatment with a standard dose of PPIs was ineffective in 21 (13.6%) patients. Causes of PPIs inefficacy in 4.5% patients were rapid PPI metabolism and in 9.1% - "driving gear" of symptoms formation related with psychic dysadaptation.

Aim. To develop criteria of early diagnosis of spontaneous bacterial peritonitis (SBP) in hepatic cirrhosis (HC). Material and methods. Clinical symptoms of SBP including systemic inflammatory reaction were analysed in 286 patients. The count of polymorphonuclear neutrophils (PNL) in ascitic liquid (AL), microbiological study of the blood and AL were made. Ultrasound investigation assessed acoustic homogeneity of AL. Blood serum (BS) and AL were tested for cytokines content: interleukine-1beta, TNF-alpha, interleukine-4, transforming growth factor beta, C-reactive protein. Gas chromatography - mass spectrometry (GC-MC) estimated quantity and quality of chemical components - markers of potential infectious agents of AL. Results. Three groups of patients were identified: group A (a classic SBP) consisted of 23 patients with clinical symptoms of SBP and PNL content > 0.25109/l; group B (control) consisted of 19 patients free of SBP symptoms and PNL content < 0.25109/l; group C (patients at risk) - 18 patients with SBP symptoms and PNL content < 0.25109/l. Cultural test of AL was negative in all the groups. Symptoms of SIR occurred equally often in groups A and C. CRP in AL was higher (23.8±4.3 g/l) in group A than in group B (p < 0.05). CRP concentration (8.6±2.1 g/l) was higher in group C than in group B (p < 0.05). Changes in cytokine composition were similar in groups A and C. The number of chemical bacterial markers was higher in groups A and C (p < 0.005). Conclusion. Patients of group C with SIR, elevated CRP, changed cytokine status, high content of chemical markers of AL infection by GC-MC are at high risk of SBP. Such patients need adequate and early antibacterial therapy.

Aim. To determine the role of immune response with production of auto- and heterologous antibodies (Ab) in development of the pathological process and in structural changes in colon mucosa (CM) in diverticulosis (Dv). Material and methods. Of 219 Dv patients, 39 were newly diagnosed with x-ray-detected signs of previous inflammation (group 1), 180 had earlier detected Dv which was confirmed and endoscopic examination detected inflammation (group 2). The comparison group consisted of 25 patients with irritable colon syndrome. The immune status was assessed by concentration of immunoglobulins (Ig), auto- and heterologous Ab. Antibodies to catalytic cytoplasmic antigens to proteinase-3, myeloperoxidase, bactericide protein BPI, tissue transglutaminase (tTG) and antiglycanic Ab were detected with solid-phase enzyme immunoassay. Results. IgA and IgG levels in group 2 were significantly higher than in group 1 and in the controls. Elevation of both IgA and IgG levels reflects activation of B-cell immunity. Group 2 patients had a higher level of Ab to endogenic peptides Saccharomyces cerevisiae (ASCA) of class IgG and IgA than group 1 and controls. The level of Ab to tissue molecules was elevated: antibodies to tTG IgG were detected in both groups - in group 2 twice more often than in group 1, while Ab to BPI - in 27% cases in group 1 and in 97% - in group 2. IgG Ab to antigens associated with phagocytic cells were detected in group 2, while Ab in group 1 were positive in single cases. Conclusion. Activation of immune response with a high concentration of IgA and IgG, Ab to tissue antigens (BPI, tTG) and IgGAb to catalytic antigens is characteristic of chronic course of Dv. Morphological changes in CM reflect different severity of inflammation-dystrophic process.

Biological methods are widely used in the treatment of intestinal inflammation (II). The TNFalpha inhibitor infliximab can quickly correct recurrence, provide long-term remission and reduce hormone need in many patients with hormone-resistant and hormone-dependent forms of Crohn's disease (CD) and ulcerative colitis (UC). However, almost half of II patients fail anticytokine therapy. Some clinical trials of biological medicines were stopped because of toxicity and complications. One of promising approaches to II treatment is now transplantation of mesenchymal stromal cells (MSC). The trial with participation of 85 CD and UC patients demonstrates that intravenous injection of allogenic MSC significantly prolongs duration of remission, reduces recurrence risk and is indicated for patients with hormone-resistent, hormone-dependent forms of II. Cell therapy can be also used in combined treatment of other gastrointestinal diseases, hepatic cirrhosis, in particular. A clinical trial is initiated of efficacy of transplantation of bone marrow autologous cells CD133+ for stimulation of regeneration of the liver in its extensive resection and cirrhosis. The future of this method depends on the results of controlled, randomized clinical trials.

Aim. To assess prevalence of gastroesophageal reflux disease (GERD) in Russia in MEGRE trial in 6 cities of the Russian Federatiion (Kazan, Kemerovo, Krasnoyarsk, Ryazan, St-Petersburg, Saransk). Material and methods. Mayo Clinic questionnaire (USA) adapted for Russia was used to question 7812 people over 18 years of age from of random population sample. The symptoms (heartburn and regurgitation) were classified as frequent if they arose once a week and more often for the last 12 months, rare symptoms arose less often than once a week. The responders with frequent heartburn and/or regurgitation were regarded as persons with epidemiological quantitative criteria of GERD. Results. Heartburn occurred in 47.5% responders: frequent in 9%, rare in 38.5%. Regurgitation occurred in 42.9%: frequent in 7.6%, rare in 35.3%. GERD prevalence was 13.3% (city range 11.3-14.3%). Frequent GERD symptoms are associated with frequent gaseous eructation (24.3%), chronic cough (22.9%), chest pain (15.1%), dysphonia (11.4%.). To stop heartburn, 88% responders took antacids, 32% - blockers of histamine H2-receptors and only 23% - inhibitors of proton pump. Only 52.8% responders with frequent chest pain and 29.3% those with frequent hearburn visited a doctor. Conclusion. The population-based trial MEGRE conducted by international methodology in 6 cities of Russia demonstrated that GERD prevalence is 13.3%. Most of the patients pay little attention to the symptoms, do not seek medical advice and, therefore, receive no adequate treatment.

The paper reviews the literature on bronchopulmonary lesion, one of the least studied systemic manifestations associated with inflammatory bowel diseases (IBD). Knowledge of the entire diversity of extraintestinal manifestations of IBD, including respiratory diseases, allows clinicians to optimize their diagnosis and treatment as the asymptomatic course of the latter may lead to the development of severe respiratory complications. The detection of bronchopulmonary pathology in its early period or during current therapy contributes to the objective assessment of the pattern of the disease, to the correction of treatment and improvement of disease prognosis.

Aim. to determine the whether mesenchymal stem cells (MSC) may be used in the treatment of patients with chronic intestinal inflammatory diseases (IID). Subjects and methods. Thirty-nine patients with ulcerative colitis (UC) (Group 1) and 11 with Crohn's disease (CD) (Group 2) were examined. Comparative groups included 30 patients with UC (Group 2) and 10 with CD (Group 4). Two-three days before MSC administration, immunodepressants were discontinued, the dosage of corticosteroids was reduced to 15-20 mg/day, and that of aminosalicylates remained to be 2 g/day. The results were quantified using the mean values of the Rachmilewich clinical activity index, the Crohn's disease activity index and the Mayo and Gebs scales. The patients were followed up for 4-8 months. Humoral immunological indices (cytokines, autologous antibodies) were determined. Bone marrow cells were obtained from the donor sternum or iliac crest. Cultivation at the end of weeks 5-6 provided a population of allogeneic donor MSC in a quantity of (1.5-2)108 cells required for transplantation to a patient. MSC cultures were once injected intravenously in a dropwise fashion. Results. A statistically significant decrease in the indices of the clinical and morphological activities of an inflammatory process was noted in 39 patients with UC and in 11 patients with CD as compared with the comparison groups after MSC transplantation. Clinicomorphological remission occurred in 40 patients. Inclusion of MSC into the treatment program was ineffective in 8 patients with UC and in 2 patients with CD. The use of MSC made it possible to discontinue corticosteroids in 34 of the 50 patients with the hormone-dependent and hormone-resistant forms of UC and CD and to reduce the dose of prednisolone to 5 mg/day in 7 patients, by administering 5-aminosalicylic acid only. Conclusion. The use of MSC may be appreciated as a new strategic direction of therapy for IID. The intravenously administered stem cells exert a potent immunomodulatory effect, reduce the activity of autoimmune inflammation, and stimulate a reparative process in the intestinal mucosa.